This K23 Award will allow the candidate to obtain the training and skills necessary to develop and lead patient-oriented research projects in pediatric ophthalmology, including multi-center clinical trials. The candidate will learn study design, protocol development, grant application, project management, data analysis, statistical methods, communication of results, and medical ethics. To achieve these objectives, the candidate will (1) work under the direct supervision of Dr. Roy Beck on several clinical trials conducted by the Pediatric Eye Disease Investigator Group, (2) obtain a masters degree in public health with a concentration in epidemiology and a minor in biostatistics, and (3) complete a research project with the guidance of Dr. Graham Quinn in retinopathy of prematurity (ROP), one of the leading causes of childhood blindness in the United States. The proposed research project will utilize digital retinal images to test our hypothesis that eyes with pre-plus disease (mild to moderately abnormal vascular dilation and tortuosity of central, posterior retinal blood vessels) are more likely to develop sight-threatening ROP. The specific aims are (1) to investigate whether pre-plus predicts progression to severe ROP (threshold disease), (2) to determine if pre-plus adds predictive value beyond that already provided by established ROP descriptors of location (zone) and severity (stage), and (3) to study the natural history of pre-plus disease. To address these aims, 2 masked experts in ROP will grade the degree of vascular dilation and tortuosity in digital retinal images generated from video indirect ophthalmoscopy in a cohort of 150 infants. Eyes with pre-plus will be compared to normal eyes in regard to the proportion that progress to threshold. There are important clinical implications if pre-plus accurately predicts progression to threshold. These include improved ability to identify high-risk infants who may benefit from earlier than usual laser treatment, more effective screening protocols for some infants, and more accurate counseling of parents regarding the risk of disease progression.